破裂脳動脈瘤急性期手術症例における術後早期CTによる脳血管攣縮の予測
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The relationship between the amount and distribution of subarachnoid clots visualized on pre- and postoperative CT scans and the incidence of symptomatic vasospasm (SVS) was studied in 61 cases of ruptured aneurysms who were operated on within 3 days of subarachnoid hemorrhage. Changes in the amount of subarachnoid clots by the surgery with a cisternal drainage were also examined.<BR>The operation was performed through a pterional approach as a rule, and subarachnoid clots were removed as much as possible around the aneurysm and from the basal cisterns of operated side. A thin silicon catheter was introduced into the prepontine cistern after opening Liliequist membrane, and bloody cerebrospinal fluid was continuously drained through the catheter for at least a week after the surgery. Postoperative CT scans were taken within 24 hours of the operation. The amount of subarachnoid blood was estimated on CT scans in the basal frontal interhemispheric fissure (IHF), the suprasellar cisterns, the stem of Sylvian fissures, and the insular cisterns. They were classified into 3 degrees as hypodense, mild high, and markedly high.<BR>Twenty cases (33%) developed SVS which was the cause of bad outcome in 9 cases (permanent spasm) and signs and symptoms of SVS had improved with time in 11 cases (reversible spasm). On the study of the distribution of subarachnoid clots, 10 of 16 cases (64%) with markedly high in the cisterns embedding both the anterior cerebral artery and the middle cerebral artery developed SVS ( 6 permanent and 4 reversible), while 7 of 22 cases (32%) with markedly high in the cisterns embedding either of the two arteries developed SVS (3 permanent and 4 reversible). Among 23 cases without markedly high, 3 cases (16%) developed reversible SVS. By the early operation associated with a cisternal drainage, the amount of subarachnoid clots was significantly reduced from markedly high to mild high or hypodense in over 70% of the suprasellar cisterns and the stem of sylvian fissures, but in 44% of the basal frontal IHF and in 27% of the insular cisterns.<BR>It is concluded that postoperative CT scans were useful in predicting patients in jeopardy of developing SVS in cases of ruptured intracranial aneurysms with an early operation.
- The Japanese Society on Surgery for Cerebral Strokeの論文
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